A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending November 18th, 2021
The following colorectal cancer treatment and research updates extend from October 14th, 2021 to November 18th, 2021, inclusive and are intended for informational purposes only.
This content is not intended to be a substitute for professional medical advice. Always consult your treating physician or guidance of a qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this website.
CONTENT
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
3. A Phase II, Open-Label, Multicentre, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population
4. Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin: Both in Combination with 5FU, Oxaliplatin, and Bevacizumab in Patients with Advanced Colorectal Cancer
5. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted?
6. Amgen Announces New LUMAKRAS™ (sotorasib) Combination Data
7. Phase 3 Trial of Regimen for mCRC Misses Primary Endpoint
8. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
9. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
10. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
11. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
12. Guardant’s Liquid Biopsy Detects 96% of Early-Stage CRC Cases with a Single Blood Draw
13. Colonoscopy Screening is the Key to Early Detection
14. COVID-19 Pandemic Shifted Patient Attitudes About CRC Screening
15. Young Adult CRC Clinic Available at Sunnybrook Hospital
16. CCRAN’s Partnership with Count Me In
17. Vanderbilt Reproductive Health Study: Partnership with CCRAN
18. Alarming Trend in Colon Cancer Cases Under 35
19. New Thinking on Aspirin and CRC Needs Dose of Nuance, Expert Says
20. Incorporating Reproductive Health in the Clinical Management of Early-Onset CRC
21. Artificial Intelligence to Detect CRC
22. Early-Onset CRC on the Rise in Whites, Stable in Blacks
23. Exercise for Cancer to Enhance Living Well (EXCEL) Study
24. Pfizer Antiviral Drug May Be 90% Effective Against Severe COVID-19
25. Frequently Asked Questions for COVID-19
DRUGS / SYSTEMIC THERAPIES
1. Phase II LEAP Clinical Trial For mCRC (Sept 10/21)
The purpose of this study is to determine the safety and efficacy of combination therapy with pembrolizumab (MK-3475) and Levantine (E7080/MK-7902) in patients with triple-negative breast cancer (TNBC), ovarian cancer, gastric cancer, colorectal cancer (CRC), glioblastoma (GBM), or biliary tract cancers (BTC). Participants will be enrolled in initial tumor-specific cohorts, which will be expanded if adequate efficacy is determined. The trial is available at the Odette Cancer Centre and at the Princess Margaret Cancer Centre in Toronto as well as the following Centres throughout Canada: Abbotsford, BC; Winnipeg, MB; CHU de Quebec. For information, visit the link below.
2. TRK Fusion Cancer And How to Test For It (Feb.16/21)
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
3. A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High CRC Metastatic Population (Sept.16/21)
The purpose of this study is to look at the effectiveness of the vaccine DPX-Survivac in combination with the drugs cyclophosphamide and the immunotherapy Pembrolizumab in patients with solid cancers who are identified to be MSI-High. All patients will receive combination therapy of DPX-Survivac, cyclophosphamide, and pembrolizumab. Patients participating will know which treatment they are receiving. The trial is currently hosted at the Odette Cancer Centre, and a new site is opening at Mt. Sinai Hospital.
4. Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin in Combination with 5FU, Oxaliplatin and Bevacizumab in Patients with Advanced CRC (Sept.16/21)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer (CRC). Patients with advanced/metastatic CRC who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- one group will receive Arfolitixorin in combination with 5FU), oxaliplatin, and bevacizumab,
- while the other group will receive the drug Leucovorin in combination with 5FU, oxaliplatin, and bevacizumab (standard of care).
The doctor and study staff will not know which group a patient is in. Patients will be randomized to receive one treatment or the other.
About Arfolitixorin:
Arfolitixorin is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced CRC. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced CRC, as it does not require complicated metabolic activation to become effective.
Treating cancer patients with arfolitixorin – The goals:
- When treating CRC, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
- Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
https://sunnybrook.ca/trials/item/?i=293&page=49335 and https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
5. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted? (Oct.08/21)
The investigational KRAS G12C inhibitor drug Adagrasib (MRTX849) yielded clinical responses in patients with non-small cell lung cancer (NSCLC) and colorectal cancer, and other solid tumors harboring KRAS G12C mutations, according the results of a from the phase I – II Krystal clinical trials. RAS is an oncogene —a gene that encodes proteins that function as switches to turn on various genes for cell growth and division. Mutations in the RAS genes result in permanently “turned on” switches that in turn result in uninhibited cell division, which can lead to cancer. There are three types of RAS oncogenes, designated NRAS, GRAS, and KRAS. Although mutations in all three can cause cancer. KRAS mutations are the most common oncogenic alteration in all of human cancers and there are currently no effective treatments available for patients with KRAS-mutant cancers. KRAS cancer driving mutation are present in 14% of NSCLC adenocarcinomas, 4% of colorectal cancers, 2% of pancreatic cancers as well as smaller percentages of several other difficult-to-treat cancers.
About Adagrasib (MRTX849)
Adagrasib is an investigational, orally available small molecule that is designed to potently and selectively inhibit a form of KRAS which harbors a substitution mutation (G12C). Adagrasib works by irreversibly and selectively binding to KRAS G12C in its inactive state, blocking its signaling to other cells and preventing cancer cell growth and proliferation; this leads to cancer cell death. Adagrasib is being evaluated in a phase 1/2 trial treating patients with molecularly identified, KRAS G12C-positive advanced solid tumors.
The phase 1/2 KRYSTAL-1 clinical trial evaluated adagrasib in 79 patients with advanced or metastatic NSCLC with a KRASG12C mutation. Results showed that nearly half (45%) of the 51 patients evaluable for clinical activity had a partial response to treatment with adagrasib, and 26 patients had stable disease. An even greater response to adagrasib was observed in the subpopulation of patients whose cancers had an STK11 mutation as well as a KRASG12C mutation. STK11 mutations have been associated with inferior responses to immune checkpoint inhibitors in patients with NSCLC. According to a report presented at the 2021 ESMO Congress Adagrasib used alone or in combination with Erbitux produced a response rate of 22% and a disease control rate of 87% in 46 heavily pretreated patients. Moreover 32 similar patients treated with the combination of adagrasib and cetuximab had a response rate of 43%, and a disease control rate of 100%. The median time to response was 1.4 months and the combination appeared well tolerated.Research suggests they may be most effective when used in combination with other precision medicines due to a resistance mechanism that develops when they are uses as a single agent.
6. Amgen Announces New LUMAKRAS™ (sotorasib) Combination Data (Oct.07/21)
Amgen announced new combination study results from the Phase 1b CodeBreaK 101 study, a trial evaluating the safety and efficacy of LUMAKRAS™ (sotorasib), the first and only approved KRASG12C inhibitor, in more than 10 different investigational combination regimens for the treatment of patients with KRAS G12C-mutated cancers.
The combination of LUMAKRAS and trametinib showed antitumor activity in heavily pre-treated patients with KRAS G12C-mutated solid tumors, including those with prior KRASG12C inhibitor treatment. A total of 41 patients were enrolled in the Phase 1b study with 18 patients with non-small cell lung cancer (NSCLC), 18 patients with colorectal cancer (CRC) and 5 patients with other solid tumors. The maximum tolerated dose tested was 2 mg trametinib/960 mg sotorasib administered daily. In patients with CRC who were KRASG12C inhibitor naïve, 9% achieved partial response, and 82% achieved disease control. In patients who were previously treated with a KRASG12C inhibitor, 14% achieved partial response, and 86% achieved disease control. The most common treatment-related adverse events (TRAEs) for this study were diarrhea, rash, dermatitis acneiform, nausea and vomiting. No new safety concerns were identified.
7. Phase 3 Trial of Regimen for mCRC Misses Primary Endpoint (Oct.22/21)
Trifluridine and tipiracil is an oral agent that utilizes a dual mechanism of action to maintain clinical activity. Trifluridine interferes with DNA function, while the blood concentration of trifluridine is maintained via tipiracil.
The randomized phase 3 SOLSTICE trial includes 856 patients with unresectable metastatic colorectal cancer (mCRC) who are not candidates for or do not require intensive therapy. Researchers randomly assigned half of the patients to first line trifluridine and tipiracil plus bevacizumab (Avastin, Genentech). The other half received capecitabine plus bevacizumab. The trial failed to meet its primary objective of a significant PFS benefit with trifluridine and tipiracil plus bevacizumab. No new safety issues or deleterious effects have been observed in either treatment group, so the trial will continue as planned.
“We remain committed to improving outcomes in mCRC and we will continue to follow patients as planned in order to perform the main secondary endpoint analysis on overall survival in 2023,” Patrick Therasse, MD, PhD, head of late-stage and life cycle management and deputy head of the oncology and immune-oncology therapeutic area for Servier, said in a company-issued press release.
SURGICAL THERAPIES
8. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Odette Cancer Centre (Oct.15/21)
The HAIP program is a first-in-Canada for individuals where colon or rectal cancer (colorectal cancer) has spread to the liver and cannot be removed with surgery. The program involves a coordinated, multidisciplinary team approach to care, with close collaboration across surgical oncology, medical oncology (chemotherapy), interventional radiology, nuclear medicine, and oncology nursing. The Hepatic Artery Infusion Pump (HAIP) is a small, disc-shaped device that is surgically implanted just below the skin of the patient and is connected via a catheter to the hepatic (main) artery of the liver. About 95 percent of the chemotherapy that is directed through this pump stays in the liver, sparing the rest of the body from side effects. Patients receive HAIP-directed chemotherapy in addition to regular intravenous (IV) chemotherapy (systemic chemotherapy), to reduce the number and size of tumours. Drs. Paul Karanicolas and Yooj Ko are the program leads and happy to see patients eligible for the therapy.
Presently at Sunnybrook Odette Cancer Centre, HAIP is being used in patients with colorectal cancer that has spread to the liver that cannot be removed surgically and has not spread to anywhere else in the body. Patients who have few (1-5) and very small tumors in the lungs may be considered if the lung disease is deemed treatable prior to HAIP. If you believe you may benefit from this therapy and/or would like to learn more about the clinical trial, your medical oncologist or surgeon may fax a referral to 416-480-6179. For more information on the HAIP clinical trial, please click on the link provided below.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
9. Living Donor Liver Transplantation for Unresectable CRC Liver Metastases (Oct.1/21)
Approximately half of all colorectal cancer (CRC) patients develop metastases, commonly to the liver and lung. Surgical removal of liver metastases (LM) is the only treatment option, though only 20-40% of patients are candidates for surgical therapy. Surgical therapy adds a significant survival benefit, with 5-year survival after liver resection for LM of 40-50%, compared to 10-20% 5-year survival for chemotherapy alone. Liver transplantation (LT) would remove all evident disease in cases where the colorectal metastases are isolated to the liver but considered unresectable.
Image Source: https://www.slideshare.net/AhmedAdel65/preoperative
While CRC LM is considered a contraindication for LT at most cancer centers, a single center in Oslo, Norway demonstrated a 5-year survival of 56%. A clinical trial sponsored by the University Health Network in Toronto will offer live donor liver transplantation (LDLT) to select patients with unresectable metastases limited to the liver and are non-progressing on standard chemotherapy. Patients will be screened for liver transplant suitability and must also have a healthy living donor come forward for evaluation. Patients who undergo LDLT will be followed for survival, disease-free survival, and quality of life for 5 years and compared to a control group who discontinue the study before transplantation due to reasons other than cancer progression.
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
10. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Oct.9/21)
Magnetic resonance-guided focused ultrasound (MRg-FU) is a lessinvasive, outpatient modality being investigated for the thermal treatment of cancer. In MRg-FU, a specially designed transducer is used to focus a beam of low-intensity ultrasound energy into a small volume at a specific target site in the body. MR is used to identify and delineate the tumour, focus the ultrasound beam on the target, and provide a real-time thermal mapping to ensure accurate heating of the designated target with minimal effect to the adjacent healthy tissue. The focused ultrasound beam produces therapeutic hyperthermia (40-42°C) in the target field, causing protein denaturation and cell damage. Currently, there is no prospective clinical data reported on the use of MRg-FU in the setting of recurrent rectal cancer. Recurrent rectal cancer is a vexing clinical problem. Current retreatment protocols have limited efficacy. The addition of hyperthermia to radiation and chemotherapy may enhance the therapeutic response. With recent advances in technology, the investigators hypothesize that MRg-FU is technically feasible and can be safely used in combination with concurrent reirradiation and chemotherapy for the treatment of recurrent rectal cancer without increased side-effects. The study is being offered at the Odette Cancer Centre. Here is the link to the study protocol:
SCREENING
11. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age (Apr.10/21)
With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), the objective of this population-based longitudinal study was to evaluate the incidence of yCRC in one-year age increments, particularly focusing on the screening age of 50 years. The study was conducted using linked administrative health databases in British Columbia, Canada including a provincial cancer registry, inpatient/outpatient visits, and vital statistics from January 1, 1986 to December 31, 2016. We calculated incidence rates per 100,000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis.
3,614 individuals were identified with yCRC (49.9% women). The incidence of CRC steadily rose from 20 to 60 years, with a marked increase from 49 to 50 years. Furthermore, there was a trend of increased incidence of yCRC among women. Analyses stratified by age yielded APCi’s of 2.49% and 0.12% for women aged 30-39 years and 40-49 years, respectively and 2.97% and 1.86% for men. These findings indicate a steady increase over one-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age.
12. Guardant’s Liquid Biopsy Detects 96% of Early-Stage CRC Cases with a Single Blood Draw (Oct.25/21)
Guardant Health’s Lunar-2 liquid biopsy test is designed to catch colorectal cancer (CRC) in its earliest stages and requires only a standard blood draw, offering a less invasive and time-consuming alternative to the current standards for screening.
On top of making testing more widely accessible, Guardant’s blood test has also been proven in clinical studies to detect signs of cancer with similar accuracy to colonoscopies and other standard screening methods. Data presented at the American College of Gastroenterology’s annual meeting this month showed that Lunar-2 was able to detect stage 1, 2 and 3 CRC with 96% sensitivity and 94% specificity. According to the company, the test can spot recurring cancers up to several months earlier than standard imaging procedures and blood tests.
The study was limited by the fact that it was a retrospective analysis of patients already diagnosed with CRC, Guardant said. The results will be further validated in the ongoing ECLIPSE clinical trial of the Lunar-2 test, which is aiming to enroll 10,000 average-risk patients by the end of this year. If the study is successful, results will be submitted to the FDA as part of Guardant’s application for Lunar-2’s approval.
Image Source: https://past.pmwcintl.com/sessionthemes-liquidbiopsy/
13. Colonoscopy Screening is the Key to Early Detection (Oct.22/21)
Many people often shudder when their doctor informs them it’s time for a screening colonoscopy. But regular screening, beginning at age 45 for people with average risk factors, is the key to preventing colorectal cancer (CRC), according to the American Cancer Society.
“There are often no signs or symptoms of CRC — that’s why it’s so important to get screened,” said Shahzad Syed, M.D., gastroenterologist on the medical staff at Navarro Regional Hospital. “A colonoscopy takes about one hour and during this time, physicians can identify, remove and test anything abnormal, such as a polyp, which is how most CRCs begin.” People over age 45 have the highest risk of CRC. You may also be at higher risk if you are African American, smoke or have a family history of CRC.
Everyone can take these healthy steps to help prevent CRC:
- Get screened starting at age 45 — earlier if you have above average risk factors.
- Encourage your family members and friends over age 45 to get screened.
- Quit smoking and stay away from secondhand smoke.
- Get plenty of physical activity and eat healthy.
https://news.yahoo.com/colonoscopy-screening-key-early-detection-191100433.html?guccounter=1
14. COVID-19 Pandemic Shifted Patient Attitudes About CRC Screening (Oct.23/21)
The impact of the COVID-19 pandemic on patients’ willingness to keep appointments for non-COVID-19 illnesses has been well documented, but a team of researchers at Virginia Commonwealth University report that for people hesitant to come into the hospital or an outpatient center to get a colonoscopy, home-administered fecal occult blood tests (FOBT) may provide a useful workaround tool.
The cross-sectional survey involved 765 people age 50 years and older. Dr. Kenning and colleagues found that almost two-thirds of respondents—65.9%—confirmed concerns about COVID-19 exposure when scheduling colonoscopies; and 59% of them said this caused them to delay their screening. However, 48.1% of respondents said they were willing to do an at-home FOBT as an alternative to colonoscopy, among whom 93% indicated they would be willing to undergo a follow-up colonoscopy if the FOBT was positive.
“The key message from our findings is that barriers to screening have increased during the pandemic, and we have to find a way to work with the community to increase those rates,” said Dr. Kristine Kenning, chief general surgery resident at Virginia Commonwealth University (VCU) School of Medicine, Richmond. “Our study found that people are compliant with, and willing to do, home-based fecal occult blood testing. This test provides a very important way for us to increase screening for colorectal cancer (CRC).” Dr. Kenning also said the survey results show that there is still much work to do to improve colorectal screening.
OTHER
15. Young Adult CRC Clinic Available at Sunnybrook (Oct.12/21)
A recent study led by the University of Toronto doctors has observed a rise in colorectal cancer rates in patients under the age of 50. The study mirrors findings from the U.S., Australia and Europe. The growing colorectal cancer rates in young people come after decades of declining rates in people over 50, which have occurred most likely due to increased use of colorectal cancer screening (through population-based screening programs) which can identify and remove precancerous polyps. Patients diagnosed under the age of 50 have a unique set of needs, challenges and worries. They are unlike those diagnosed over the age of 50. Dr. Shady Ashamalla (colorectal cancer surgical oncologist), and his team at the Sunnybrook Health Sciences Centre understand the needs of this patient population.
Dr. Ashamalla belongs to a multidisciplinary team of experts in the Young Adult Colorectal Cancer Clinic who will work with young colorectal cancer patients, regardless of disease stage, to create an individualized treatment plan to support each patient through their cancer journey. Their needs and concerns will be addressed as they relate to:
- Fertility concerns and issues
- Young children at home
- Dating/intimacy issues
- Challenges at work
- Concerns about hereditary cancer
- Relationships with family and friends
- Psychological stress due to any or all of the above
The team of experts consists of:
- Oncologists (medical, surgical, radiation)
- Social workers
- Psychologists
- Geneticists
- Nurse navigator
Should a patient wish to be referred to Sunnybrook, they may have their primary care physician, or their specialist refer them to Sunnybrook via the e-referral form, which can be accessed through the link appearing below. Once the referral is received, the Young Adult Colorectal Cancer Clinic will be notified if the patient is under the age of 50. An appointment will then be issued wherein the patient will meet with various members of the team to address their specific set of concerns.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
16. CCRAN’s Partnership with “Count Me In” (Nov.01/21)
CCRAN is proud to partner with Count Me In, a nonprofit research initiative, on The Colorectal Cancer Project. This new project is open to anyone in the United States or Canada who has ever been diagnosed with colorectal cancer (CRC). Patients can find out more and join at JoinCountMeIn.org/Colorectal.
Through the project, patients are asked to complete surveys to share information about their experience with CRC, to share biological sample(s), and to allow for the research team to request copies of their medical records. The project team then de-identifies and shares data from these with the entire research community.
Every patient’s story holds a piece of the puzzle that can help us better understand CRC. By discovering more about what drives cancer and sharing this data, CCRAN and the Colorectal Cancer Project believe insights can be gained to develop more effective therapies. One of the aims of the project is to reach populations that have been understudied, including individuals who are diagnosed with CRC at a young age, individuals from marginalized communities who have historically been excluded from research, and patients with metastatic CRC. Together, we can accelerate our understanding of CRC. To learn more or sign up to participate, visit JoinCountMeIn.org/Colorectal.
“Count Me In”, a nonprofit cancer research initiative, is inviting all patients across the United States and Canada who have ever been diagnosed with colorectal cancer (CRC) to participate in research and help drive new discoveries related to this disease. The Colorectal Cancer Project will enable patients to easily share their samples, health information and personal lived experiences directly with researchers in order to accelerate the pace of research.
Patients who have been diagnosed with CRC at any point in their lives can join the project by visiting JoinCountMeIn.org/colorectal. From there, patients will be invited to share information about their experience through surveys and to provide access to medical records as well as saliva samples and optional blood, stool, and/or stored tissue samples for study and analysis. Researchers from the Broad Institute of MIT and Harvard and Dana-Farber Cancer Institute use this information to generate databases of clinical, genomic, molecular, and patient-reported data that is then de-identified and shared with researchers everywhere. To date, more than 9,000 patients with different cancers have joined Count Me In and shared their data.
“We still do not know why there is an alarming rise in CRC in young adults”, said Andrea Cercek, MD Co-Director, Center for Young Onset Colorectal and Gastrointestinal Cancers Memorial Sloan Kettering Cancer Center and co-scientific leader of the Colorectal Cancer Project. “What we do know is that this is a global phenomenon that affects otherwise healthy individuals with no known risk factors. The Colorectal Cancer Project will provide researchers important information that will lead to a better understanding of this disease.”
150 patients have joined the Colorectal Cancer Project since the September launch to drive forward research and discoveries.
17. Vanderbilt Reproductive Health Study: Partnership with CCRAN (Oct.31/21)
If you were diagnosed with cancer between ages 18 and 49, please share your experiences in a confidential, 30-minute online survey to help us learn more about how cancer and its treatments may impact reproductive health, here: www.thereactstudy.org.
With the Reproductive Health After Cancer Diagnosis and Treatment (REACT) Study, we hope to gather valuable information from individuals like you that will help us to better understand the highest needs and concerns are related to reproductive health—specifically for individuals diagnosed with a cancer before age 50.
18. Alarming Trend in Colon Cancer Cases Under 35 (Oct.27/21)
Young adults with colon cancer are just as likely to die from the disease as older people — in some cases, maybe even more likely — according to a study to be published in the Journal of the National Cancer Institute. “It struck us that these patients were younger, they had fewer comorbidities, they had better performance status and were more physically active and they had less side effects from the treatment,” said Kimmie Ng, director of the Dana-Farber’s Young-Onset Colorectal Cancer Center. “But their survival was exactly the same,” she said.
While her study group had too few patients younger than 35 to have a statistically significant result, Ng said the team observed a “particularly concerning” trend of lower survival rates in that population. It’s still unknown whether cancers that happen in younger people are biologically different than cancers that happen in older people. “We need to better understand what it is that is different about the very youngest patients,” Ng said.
19. New Thinking on Aspirin and CRC Needs Dose of Nuance, Expert Says (Oct.22/21)
The U.S. Preventive Services Task Force is re-evaluating recommendations on the use of aspirin to prevent colorectal cancer (CRC). The Harvard Gazette spoke with Andrew Chan, director of cancer epidemiology at the Mass. General Cancer Center and a professor at Harvard Medical School, about the new thinking around aspirin. Chan says that the evidence for the medicine’s effectiveness in preventing CRC remains compelling and called for a nuanced approach to any revision of recommendations. If you look at the overall compendium of data, the aspirin link to lower CRC rates is quite convincing.
Gazette: You reported results in January that seem to confirm aspirin’s effectiveness among older adults. Can you tell us about the study?
Chan: One reason we conducted our study is that we wanted to understand why, in a recent clinical trial of aspirin started in adults over the age of 70, there was no benefit in terms of cancer — and possibly an increased risk of cancer deaths. We found that if you had started taking aspirin at a younger age, you could still potentially benefit after age 70 in terms of CRC risk. This illustrates that it may be a challenge to make blanket statements about whether you should or shouldn’t take aspirin at a certain age without taking into account when you first start and how long you take it for. Of course, it’s difficult for a group like the U.S. Preventive Services Task Force to account for this nuance in the data because their goal is to provide a simplified recommendation. But it is an important detail. If you simplify the recommendations too much, there is the risk that people get confused and disregard a potentially life-saving intervention as being ineffective in all situations.
Gazette: In the end, “Oh, I better stay away from aspirin,” would be the wrong takeaway for an individual reading about the task force’s deliberations, correct?
Chan: It would be a mistake to jump to the automatic conclusion that it’s not going to be beneficial. It’s still worth discussing with your doctor and for the scientific community to pursue further research. This speaks to the need for doing additional studies in the right populations.
20. Incorporating Reproductive Health in the Clinical Management of Early-Onset CRC (Sept.23/21)
Among young patients, there is a greater need to treat the whole patient for whom multiple life domains (eg, sexual health and fertility) are significantly affected by the cancer diagnosis. Yet when asked about their experience of being diagnosed with cancer, lesser than two thirds of adolescent and young adult patients are informed that cancer treatment could pose an infertility risk.
Gonadotoxicity and sexual dysfunction are well-documented for patients with cancer across other tumor types (eg, lymphoma, breast, and germ cell). However, the population of patients with early-onset colorectal cancer (CRC) differs as rates of sexual dysfunction are higher in CRC (across all age groups, including early-onset CRC) compared with all cancer survivors. As a result of CRC-specific treatment regimens such as, pelvic radiation, abdominoperineal resection, mesorectal surgery, and cytotoxic chemotherapies, young patients with CRC may encounter unique survivorship challenges that can detrimentally affect fertility and/or sexual health. A qualitative analysis has identified impact on quality of life—including physical side effects (eg, sexual dysfunction)—as the highest area of concern resulting from an early-onset CRC diagnosis.
This initial evidence illuminates the importance of addressing fertility preservation and offering counseling for sexual health, including function and satisfaction, to patients with CRC age 18-49 years. It also sheds light on our limited knowledge of the unparalleled challenges (eg, severity and type of sexual dysfunction) that patients face after an early-onset CRC diagnosis—which stands as a substantial roadblock in tailoring support strategies to this population.
https://ascopubs.org/doi/full/10.1200/OP.21.00525
Image Source: https://www.intimina.com/blog/signs-infertility/
21. Artificial Intelligence to Detect CRC (Nov.02/21)
A Tulane University researcher found that artificial intelligence (AI) can accurately detect and diagnose colorectal cancer (CRC) from tissue scans as well or better than pathologists, according to a new study in the journal Nature Communications. “This study is revolutionary because we successfully leveraged AI to identify and diagnose CRC in a cost-effective way, which could ultimately reduce the workload of pathologists” said Dr. Hong-Wen Deng, professor and director of the Tulane Center of Biomedical Informatics and Genomics at Tulane University School of Medicine.
Using images, which were randomly selected by technicians, they built a machine assisted pathological recognition program that allows a computer to recognize images that show CRC. “The challenges of this study stemmed from complex large image sizes, complex shapes, textures, and histological changes in nuclear staining,” Deng said. “But ultimately the study revealed that when we used AI to diagnose CRC, the performance is shown comparable to and even better in many cases than real pathologists.”
Using artificial intelligence to identify cancer is an emerging technology and hasn’t yet been widely accepted. Deng’s hope is that the study will lead to more pathologists using prescreening technology in the future to make quicker diagnoses.
https://www.sciencedaily.com/releases/2021/11/211102180535.htm
22. Early-Onset CRC on the Rise in Whites, Stable in Blacks (Nov.09/21)
Rates of early-onset colorectal adenocarcinoma increased among the white U.S. population over the past 2 decades, approaching rates in the Black population, which remained stable, a cross-sectional study revealed.
For individuals ages 40 to 49, the rate of colorectal adenocarcinoma in the white population increased from 19.6 to 25.2 per 100,000 person-years from 2000 to 2017, for an annual percent change (APC) of 1.6. In the Black population, rates changed from 26.4 to 25.8 per 100,000 person-years over the study period, a non-significant dip, reported Jordan J. Karlitz, MD, of the University of Colorado School of Medicine in Denver, and colleagues.
Among white women, rectal adenocarcinoma specifically increased over the study period, as compared to a non-significant drop among Black women. “Our analysis is the first to find that white women may be a significant driver of overall increases in rectal cancer rates,” the group wrote in JAMA Network Open, citing obesity as a significant contributing factor to early-onset disease.
Overall, the absolute rectal adenocarcinoma incidence rate was 39% lower among the Black population as of 2017, the authors noted, with a possible contributing factor including the early “introduction of a screening threshold of age 45 years in Black individuals.”
https://www.medpagetoday.com/gastroenterology/coloncancer/95551
NUTRITION/HEALTHY LIFESTYLE
23. EXercise for Cancer to Enhance Living Well (EXCEL) Study (Oct.14/21)
Project EXCEL is EXercise for Cancer to Enhance Living Well, and is a research study that provides a FREE exercise oncology program to people living with and beyond cancer in rural and underserved areas across Canada. EXCEL offers both online, and when safe and available, in-person programs. Exercise is SAFE and EFFECTIVE for those living with and beyond cancer, and our classes are run by trained exercise professionals.
To hear from past EXCEL participants, please watch this video:
https://www.youtube.com/watch?v=k68nQXq_ntI&ab_channel=Health%26WellnessLab
Benefits of taking part in the EXCEL program:
COVID-19 UPDATES
24. Pfizer Antiviral Drug May Be 90% Effective Against Severe COVID-19 (Nov.08/21)
Pfizer announced its new oral antiviral treatment significantly reduced the risk of hospitalization and death from COVID-19. Results from the company’s phase 2 and 3 clinical trials found the drug, called Paxlovid, was nearly 90% effective at preventing severe disease symptoms when given to high-risk study participants.
The findings, which are not yet peer reviewed, show that participants who took Paxlovid were much less likely to be hospitalized than participants who received placebo pills. No participant given the antiviral pill died, but 10 who received placebo pills did. Clinical trial results also show Paxlovid is highly effective against SARS-CoV-2 variants of concern (VOC) as well as other types of coronaviruses.
While the results are promising, experts say that without adequate supplies of rapid tests for COVID-19, these drugs won’t be used effectively. They also emphasize that COVID-19 antiviral drugs aren’t the way we’ll end the COVID-19 pandemic. Rather, vaccinating at least 80 percent of the population will end the pandemic.
25. Frequently Asked Questions for COVID-19
Q: What is COVID-19 (or novel Coronavirus Disease – 19)?
A: Coronaviruses are a large family of viruses that can cause illnesses in humans and animals. Coronaviruses can cause illnesses that range in severity from the common cold, to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and most recently, COVID-19. COVID-19 or novel coronavirus originated from an outbreak in Wuhan, China in December 2019. The most common symptoms associated with COVID-19 can include fever, fatigue, and a dry cough. Though additional symptoms have now been linked with the disease, which may include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, skin rash and vomiting. It is also possible to become infected with COVID-19 and not experience any symptoms or feeling ill. The spread of COVID-19 is mainly through the transmission of droplets from the nose or mouth when a person coughs, exhales or sneezes. These droplets land on surfaces around a nearby person. COVID-19 can be transmitted to that nearby person who may end up touching the surface contaminated with COVID-19 and then end up touching their nose, mouth, or eyes. A person can also contract COVID-19 through inhaling these droplets from someone with COVID-19. Although research is still ongoing, it is important to note that older populations (over the age of 65), those with a compromised immune system and those with pre-existing conditions including heart disease, high blood pressure, lung disease, diabetes or cancer may be at a higher risk of severe illness due to COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Q: What can I do to avoid getting Coronavirus?
A: There are various ways in which we can reduce our risk of contracting COVID-19. Below are some measures suggested by the World Health Organization
- Keep at least 2 metres (or 6 feet) between yourself and other people. This will reduce the risk of inhaling droplets from those infected with COVID-19.
- Regularly clean your hands for at least 20 seconds with warm water and soap, or an alcohol-based hand rub. This will kill any viruses on your hands.
- Avoid touching your eyes, nose and mouth. If the virus is on your hands, it can enter the body through these areas.
- Follow good respiratory hygiene by covering your mouth and nose with a tissue or elbow when you cough and sneeze. This prevents the droplets from settling on surfaces or being released into the air around you.
- Stay home as much as possible, especially if you are feeling unwell. If you think you may have the Coronavirus, please see “What should I do if I think I have Coronavirus?” section.
- Please wear a face covering or mask in public when physical distancing is not possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Q: Are there special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811
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